Why we must never repeat the mistakes of a ‘gender-blind’ COVID response

Harry Bignell Gender, Health, Inequality

Pandemics are bad for women’s health – but they are also bad for their labour rights, suggests research from Matahari Global Solutions and the People’s Vaccine Alliance. Harry Bignell and Abha Jeurkar set out key gendered impacts of the pandemic – including the impact on trans and non-binary people – and call for pressure on global leaders to make sure we avoid them in future.

Johana, a domestic worker in Spain and migrant from Honduras, pictured in 2020. She helped to found a workers’ association that supported women migrant care and domestic workers with basic living costs as their jobs were disrupted by the pandemic, helped by funding from Oxfam (picture: Pablo Tosco, Oxfam Intermón)

Did you know that 91% of policies to address the COVID-19 pandemic were completely gender-blind? This statistic reveals just how much policy makers neglected the specific needs of women and gender-diverse people.

In this blog, we address four notable areas of gendered impact:

  • that women were over-represented in riskier occupations;
  • that they were more economically vulnerable, including to job losses;
  • that the burden of labour generated by lockdowns and other pandemic measures, especially in care, fell harder on women; and
  • that trans and non-binary people fell through the cracks of public health and other structures designed around the needs of cisgendered people.

As global leaders negotiate a new accord to shape future pandemic response, they need to ensure such gendered pandemic impacts are at the heart of their discussions.

1. Women were in riskier occupations and generally less safe

In March 2021, the International Labour Organisation (ILO) published its country-level policy tool to support tracking of gendered employment impacts of the pandemic. In it, the ILO states, “Women everywhere are bearing the brunt of this crisis because of the compound effect of many factors. They are at higher risk of job losses not only because they are disproportionately employed in sectors highly affected by the lockdown (such as accommodation and food services, and retail trade) but also because they tend to be the first to be dismissed in any sector, due to their more tenuous employment situation relative to men.”

Women were also on the frontline of the global pandemic responses. Women healthcare workers comprise more than 70% of the global health workforce and 90% of health workers in patient-facing roles. Globally, professions dominated by women – such as nurses, flight attendants, and personal care aides – were among the most vulnerable to getting COVID-19 and spreading it to others.

For instance, community health workers – who are mostly women – continued working through the COVID-19 pandemic to collect sputum samples, provide nutrition to TB patients for TB medication adherence, and to disseminate COVID-19 information. Many worked without salaries in risky environments, at risk of arrest and police harassment due to breaches of PPE and lockdown regulations, even having to dip into their own pockets to support patient nutrition.

These challenges did not end with the working day either. Women and non-binary people were also at more risk of unsafe situations across the pandemic, with increased reports of gender-based and domestic violence. Trans women faced particular dangers, as they were forced to lock down in non-affirming environments.

Research from health research and policy organisation Matahari Global Solutions found that in South Africa, for example, trans women in rural areas experienced great difficulty in accessing healthcare. Reduced protection from community services and support correlated with an increase in physical and mental attacks on transgender people. The authors argue that legal gender recognition is a prerequisite of harassment-free health for transgender people, and must be seen as essential within a public health framework.

Though more men were infected with and died from COVID-19, women faced extra risks to their safety and health when they could not access vaccines and treatment. Barriers included cultural constraints such as needing to be accompanied by a man to the clinic, and practical barriers such as having little or no access to a vehicle, or being short of time to take up care, because they were juggling childcare and other domestic tasks.

These existing constraints were sometimes compounded by their race or legal status in the country as well. Safety became a barrier in some situations, with undocumented migrants being seen as easy targets for COVID-19-related xenophobia and racism. For example, in 2020, the Malaysian government rounded up and detained hundreds of undocumented migrants and Rohingya refugees under the guise of containing the virus. Whilst this impacted men and women, the multitude and complexity of constraints facing women meant that in many situations, women went without lifesaving vaccines, tests and treatments.

2. Women were more economically vulnerable

Around the world, the pandemic hit women the hardest in the percentage of jobs lost: 4.2% as compared to 3% of men. Lack of savings and having dependents also make women less resilient to economic shocks such as pandemics.

We know that women suffer the most in times of crisis, being underpaid and having less access to financial resources than men. Even without pandemics, women are the most economically vulnerable, comprising nearly 60 percent of workers in low-wage occupations.

This economic vulnerability is rooted in so much of women’s labour being undervalued or unpaid, despite contributing over trillions to the global economy annually. For instance, women in health tend to occupy lower status, low paid, and often unpaid roles. Even as the number of women in high-paid jobs in the health sector is steadily growing globally, they still earn 24% less than their male counterparts. Women are still less likely to be in fulltime jobs.

Yet these risks and vulnerabilities are conveniently forgotten when pushing women into the frontline of the pandemic response. Matahari Global Solutions found that health systems reflect longstanding patriarchal attitudes where “women are being considered more resilient when it serves the system, and weak when it serves otherwise.”

3. The burden of extra labour in the pandemic, especially care, fell harder on women

A study conducted in some of the richest countries of the world showed that women on average spent 7.7 more hours a week than men on unpaid childcare during the first year of the pandemic, forcing some to quit their jobs altogether. One in four women are considering leaving the workforce or downshifting their careers since the pandemic, versus one in five men. Most impacted were working mothers, women in senior management positions, and Black women.

Those women on the frontline of the response found themselves doubly impacted, facing huge extra pressures at work while having to do the extra unpaid labour of care for family at home. Dr Sameera Al Tuwaijri from the World Bank says, “This is a huge gender issue, how women are a majority of frontline health care workers and having to simultaneously care for people at home during the pandemic.”

For a time during the pandemic, the whole care economy, paid and unpaid, attracted a spike in public and political interest like never before (see graph below). School closures and working from home brought an increased recognition of the work that (mostly) women do at home; cooking, cleaning, and taking care of children, people with disabilities and the elderly. Meanwhile, the public showed its support in many countries for the healthcare workforce. In the UK, for instance, swathes of people stood on their doorsteps weekly clapping health workers – three quarters of whom are women.

How recognition of care workers was short lived

Trend for the search term “care workers” over the past couple of decades, which spiked over the pandemic but has now fallen back again (source: Google Trends)

Sadly, there has since been a rapid decline in people’s interest in care workers and the extra unpaid care work done by millions of women in the pandemic seems to have been forgotten. It is vital that we remember this extra labour and sacrifices by women as the world looks to prepare for the next pandemic.

4. Trans and non-binary people fell through the cracks

Criminalisation of gender identity and cultural norms in some countries, meant trans and non-binary people faced significant safety barriers in accessing vaccines and were discriminated against by healthcare workers.

Several civil society organisations report that trans people were worried about accessing health services because of fears of getting arrested by the police, being forced to quarantine with the gender they were assigned at birth, or not having an ID card that matched their gender expression.

A representative from the advocacy and rights organisation Sama Resource Groups for Women and Health reflects: “For trans people, there is a lot of apprehension to go to a public health facility. From our experience they like to go to a private sector clinic so they can avoid the discriminatory behaviours and intrusive questions.” Yet private clinics have cost implications, and trans people unable to afford private clinics were forced into unsafe and uncomfortable health contexts.

Matahari Global also found that job redundancies due to COVID-19 often meant trans people were confined to non-affirming environments, putting them at higher risk of overlapping comorbidities of mental health and COVID-19.

Yet these specific impacts on trans and non-binary people were conspicuously absent in the pandemic policies of many governments and of organisations such as the World Bank and Gavi, the vaccine alliance, both of which use a binary understanding of gender. It is urgent that policies for the next pandemic ensure that trans and non-binary people get the same protections, access and rights as everyone else. They must not be allowed to fall through the cracks again.

Gender-sensitive approaches must be at the heart of the new pandemic accord

Gendered impacts were disastrously neglected in the response to COVID-19. Matahari Global Solutions’ research suggests that even where gender approaches were acknowledged as necessary, they were poorly conceived and implemented, with most gender-responsive interventions being added in belatedly to existing responses, rather than designed in from the start.

Crucially, any future response must learn lessons from this neglect and be co-created with at-risk communities, feminist organisations and LGBTQIA+ organisations. LGBTQIA+ organisation Kaleidoscope Trust emphasises the need for policy makers to listen to the lived experiences of LGBTQIA+ people and other historically oppressed and vulnerable groups to enact policy to meet their needs and address discrimination. A seat at the table is a critical first step.

Currently, world leaders are engaged in negotiations over a ‘Pandemic Treaty’, although progress has stagnated and its future remains uncertain. If enacted properly, this provides an opportunity to guide global prevention, preparedness, and response for future pandemics in a way that centres equity, justice and gender.

So much damage has been done in recent years by neglecting the gendered impacts of COVID-19. New pandemic architecture such as the Pandemic Treaty must remedy this and put an intersectional and gender-sensitive and/or gender-transformative approach right at its heart.

Author

Harry Bignell

Harry Bignell is Health Policy Adviser at Oxfam GB

Author

Abha Jeurkar

Abha Jeurkar is a trainee at Oxfam GB, currently working with the Health Policy and Advocacy team.

Find out more: Read the full report from Matahari Global Solutions and the People’s Vaccine Alliance: Covid-19 and gender: best practices, challenges, and lessons for future pandemics.
Also check out this blog about the challenges facing the pandemic treaty: “The pandemic treaty must put people before big pharma profits.”